By Clay Coleman
VANDALIA—Leslie Dahl complained under her breath as she wheeled her ambulance around the man’s house. The city was fixing the sidewalks, so she turned the vehicle around and tried again. Only moments before, a voice over the radio told her a man in Vandalia was complaining of chest pain. She had to take him to the hospital in Hannibal. As she placed her ambulance in park and met her partner outside, a neatly dressed woman stood in the doorway and urged them to come on.
Originally from Iowa, Dahl followed her parents down to Missouri in the ’90s. Not wanting a life in the restaurant business, she decided to do what she was good at instead. Dahl had taken care of her grandparents before they died. She was good at taking care of people. Maybe, she could take care of others as well. Petrified of needles, though, Dahl skipped becoming a nurse and became an Emergency Medical Technician. Her job entailed providing primary medical care to the sick and injured, and she didn’t have to use any needles to do it. All Dahl had to do was keep them alive until they got to the hospital. Keep them alive until they were under the hospital’s lights and the surgeon’s blade.
Dahl and her partner grabbed their equipment and followed the woman inside to the bedroom. The man was lying partly on the bed, fully clothed and dressed in denim, his boots dangling off the side. Dahl thought she recognized the man, but couldn’t look past the grey in his face. His forehead was pale and clammy. His beard was wet with sweat. The man was pointing to his chest, telling Dahl where it hurt. He could pinpoint the pain to her. She didn’t need to wait for her partner to finish taking a set of vital signs to know they needed to leave right now.
Dahl leans down and tells the man he needs to go to the hospital, but the man is stubborn. He argues for his wife to take him. Dahl shakes her head and looks up at the wife. She tells her husband that she wished he would go in the ambulance. She would follow him to the hospital later. Dahl motions for her partner to put the blood pressure cuff away and help her load the man into the ambulance. The man refuses to get on the gurney and walks to the ambulance instead. As Dahl and her partner help the man step into the ambulance, Dahl decides to drive. Her partner is a new medic. It’s still dark outside, and she knows the way. As she pulls away from the residence, Dahl contacts dispatch and tells them they are en route to the hospital in Hannibal. Her partner, a rookie she worked with while he was in training, tends to the man in the back.
An EMT for a little over a year, Brandon Osborne felt safe with Dahl in the ambulance. Dahl was highly respected back at the station and knew what she was doing. Osborne had been a deputy sheriff in Monroe City for 13 years, and before that, he was a 911 dispatcher. Osborne was tired of police work, though. It was getting too political nowadays. He planned on getting his paramedic certificate eventually and go full time as a medic. He enjoys public service. He considers himself not built to sit behind a desk.
While Dahl races through the streets of Vandalia, Osborne attaches the ambulance’s equipment to the man. A cuff around his arm tells Osborne the man’s blood pressure is still too high. He tapes a probe around his finger and is relieved that the man is doing good breathing on room air. Still grey and sweating profusely, the man is capable of talking to Osborne coherently, yet Osborne notices the man’s heart rate start to skyrocket.
Listening to her partner talk to the man, Dahl settles down and focuses on driving. As long as the man is alert, Dahl knows her partner is ok. Watching the lines along the highway as she races the ambulance in the dark, Dahl reminds herself about two patients she lost a couple of years back. One died on her on Thanksgiving day. A month later, she loses another on Christmas morning. The books never talk about the emotional weight a medic has to carry. A family’s grief is shared by the last person to see them alive.
Just outside of Curryville, Dahl’s partner yells from the back that the man’s heart rate is increasing. He tells her to light em up! Dahl turns on the ambulance’s lights but hesitates turning on the siren. With some patients, the noise only increases anxiety. Cardiac patients frighten Dahl. A basic EMT can only provide minimal care for cardiac patients. Paramedics can administer medications, place advanced airways, and shock the heart to either slow down or increase a patient’s rate. Dahl and her partner cant do any of that. In small towns across the U.S., paramedics are at a premium. Small towns can’t afford to have many on staff.
One mile south of the Frankford exit, about 20 minutes from the hospital in Hannibal, Dahl hears her partner calling out the man’s name. Dahl immediately pulls the ambulance over to the side of the highway. No sooner does she put the vehicle in park, her partner sticks his head between the front seats and tells her the man’s stopped breathing. Dahl gets on the radio and contacts dispatch. “We need an Advanced Life Support ambulance sent our way immediately,” she tells them. Placing the radio down, Dahl exits the ambulance just as the sun starts to break in the east, and races towards the rear of the vehicle.
Dahl can tell the man is in cardiac arrest. Closing the back doors, she kneels next to the patient and tries to elicit a response from the man. When she gets none, she looks at her partner and tells him to get the patches out. The Automatic External Defibrillator is a device that anyone can use with just a little bit of training. It analyzes a patient’s heart rhythm, tells you when to do CPR, and advises when a shock is necessary. The shock is an electrical charge straight to the patient’s heart. It stops it from beating erratically, with the hope that the rhythm returns to normal. Dahl notices the frantic look in her partner’s eyes. He’s only seen a cardiac arrest during training.
While Osborne places the patches on the man’s chest and starts doing compressions, Dahl places oxygen on her patient. Since the man has stopped breathing, she grabs a bag valve mask from a drawer in the back of the ambulance. It’s a device that delivers oxygen every time she squeezes the bag. It’s hard to maintain a seal with the mask, though. The man’s beard is still wet with sweat, and Dahl struggles to keep the oxygen from leaking out the side. Attempting to maintain a tight seal, Dahl gets on the radio and again requests paramedics to meet her on the side of the road. Ralls County ambulance refuses to come because Dahl is still in Pike County. Pike County says Dahl’s ambulance is almost out of their county, to contact Ralls. Dahl realizes Osborne and her are alone.
After two minutes of doing CPR in the back of the ambulance, the AED advises the medics to shock the man. Once both medics are clear, Dahl hits the shock button. Osborne smiles at Dahl and tells her he can feel a pulse. Dahl lets out a sigh of relief. She starts to shuffle her way back towards the front of the vehicle, when her partner says, “Wait a minute. I’m losing it. I’m losing it. I’ve lost a pulse.” Dahl goes back down to the patient’s head and continues to ventilate, while Osborne starts the compression cycle all over again.
By this time, Dahl is praying the man’s wife doesn’t catch up to her ambulance. She doesn’t want the woman to see her husband like this, stopped along the highway, fighting for his life. After two more minutes of CPR, the AED advises giving another shock. Once again, Dahl and her partner stop what they’re doing and shock the man. Suddenly, the man’s arms stiffen and rise in the air. He gasps and starts looking at the medics, talking incoherently. Dahl looks at her partner. “Brandon, we have no help coming. We have got to move,” she tells him.
Turning on her lights and siren, Dahl pulls back on to the highway. She picks up her phone and calls the emergency room at the hospital and gives a situation report. Everyone has scanners in rural communities, so she’s not allowed to provide patient information over the radio. She speaks to the ER charge nurse. The nurse tells Dahl that they are expecting them and that they’ll stay on the line until she arrives. Just then, dispatch calls her on the radio and tells her to pull over. Audrain County EMS said they would catch up to her. Relaying that information to the charge nurse waiting on the phone, the nurse tells her to “keep going.” “Do not stop that ambulance,” the nurse tells Dahl, “As long as the patient is responsive, you keep that ambulance moving!”
About 10 minutes later, Dahl pulls the ambulance into the emergency room parking lot. The charge nurse is waiting there at the door. Dahl watches as the hospital staff lifts the man off the gurney and into a hospital bed. The man is awake and looking at his surroundings. As Dahl and her partner start retrieving their equipment, she notices the man’s wife entering through the sliding doors. She doesn’t have the heart to tell her what had just happened.
Every one of us is in a race. For some, that race is as simple as putting food on the table. For others, it’s ensuring our children get a proper education, pay our mounting debts, or meeting an editor’s deadline. But the sweetest race of all is the race of life. And for Leslie Dahl and Brandon Osborne, not only did they finish the race, they were victorious.
Editors note: Leslie Dahl and Brandon Osborne were recognized for their achievements by receiving the Clinical Save Award, by AED maker Zoll Technologies. Due to patient confidentiality, the patient’s name has been omitted from the story.